By Onesmus Kansiime

Question 1: What will happen if there are no doctors? Short lives (Quick Death).

Question 2: What will happen if there is one well paid doctor for every 1,000 persons in Uganda? longer healthy lives.

Reasons for raising salaries of the health workforce are obvious; Since the health workforce is at the frontline of fighting disease, the government should support them by increasing their compensation.

I’m also aware that wage increase may reduce funding available for other critical medical supplies and that wage increase for one category of workers may trigger demands by other workers. However, it must be noted that the economy loses more from a sick population than it saves from paying health workers peanuts.

Therefore, for Uganda to make significant progress towards health equity and economic growth, it must devote resources and expand investments to build health worker capacity and their compensation. For instance, Uganda’s economy grew by only 2.9% in the financial year 2020 compared to the 6.8% growth recorded in the financial year 2019 largely due to COVID-19 and an unhealthy population. It is still obvious that when we pay doctors for their value and management of people’s health not just their services, they improve the health outcome leading to an improved bi-product of health equity.

I am not writing about the supplementary budget in which medical interns placed their hopes for a pay rise because it is a joke to think that a country, whose leaders are comfortable with an economy that loses over sh10 trillion to Corruption in the name of ‘good thieves that invest their loot within her borders’, would place her hopes in a sh3.8 trillion supplementary budget of which close to 30% will be embezzled if the standards of looting are maintained. I write fully aware that promises of pay rise for different categories of workers have been made and not fulfilled and I will not make new demands but will slightly emphasize the old ‘delicate’ promises.

Be convinced that the Government’s response to the medical interns’ industrial action could plunge the nation into regrettable health inequity.

It is time to relate the effect of health work understaffing to our health in 2021 when the health care system has been strained by the fight against COVID-19 and the undercover proliferation of the formerly won diseases. According to a study by Stewart Walukaga et al 2021 with adults on Anti-Retroviral Treatment, 76% of clients indicated that COVID-19 negatively impacted travel to HIV clinics; 54% perceived that coming to the clinic increased their risk of acquiring COVID-19; 14% said that COVID-19 had impacted their ART adherence. It is not enough to manage COVID-19 when people are dying of other conditions. The reason why we are not giving equal attention to all conditions is because we don’t have enough health care workers. Worse still, we undercompensate and send away the few that are willing to stand with the nation.

Being a health care worker in 2021 calls for an awareness of social injustices and the will to help end them. At the same point, the government should beware that the health workforce, being a strong set in eliminating health inequity, should never stand a risk of losing any element of its set.

Health inequities prevent the attainment of the minimum standards of health for everyone. These minimum health standards are the highest standards of health enjoyed by the most privileged. Everyone must enjoy the available ceiling of health standards at a given period of time not the floor of standards. The number of health workers greatly determines the scale of health equity. The quality and distribution of the health workers directly influence the quality and quantity of health services and the long-term development of the medical system. We cannot fix health inequity without having a constructive conversation and consideration for health care workers.

Uganda lies behind in health indicators with an average life expectancy at 63.4 years only above Burundi in the East African Community, 46 deaths per 1,000 under-fives in 2020 compared to 45.8 deaths in 2019, 20 neonatal deaths per 1,000 live births, and maternal mortality of 375 per 100,000 births, 1.5 million people living with HIV/AIDS and a 6.2% HIV/AIDS prevalence. These statistics can be improved by many interventions to include having more and well-paid medical personnel.

There are only 0.168 doctors per 1,000 Ugandans. To meet the World Health Organization’s recommendation of 1 doctor per 1,000 persons, Uganda has a deficit of 37,440 doctors and therefore doesn’t have the luxury of sending away 1,403 medical interns and thinking it will not have an impact on the population’s health and demotivation of the medical profession. These 1,403 medical interns would be responsible for the health of 8.4 million Ugandans as per the ratio of 0.168 doctors for every 1,000 Ugandans. In Uganda, 70% of medical doctors serve in urban areas where only 20% of Ugandans live. This means that there are only 0.068 doctors available for every 1,000 rural persons compared to the 0.588 doctors per 1,000 urban persons. The uneven distribution of health workers across rural and urban areas is due to scarcity of personnel and the search for greener pastures.

Therefore, the medical interns should resume their work and training at health facilities not only for their educational benefit but also our health benefit and the motivation of doctors; The suspended/ sent away medical interns should finish their second rotation and get signed off; The government must fulfill its promise of better pay.

A country with a bad health equity record worldwide, poor performance on health indicators, a Human Development index of only 0.544 (159^th in human development), 127^th according to the Legatum Prosperity Index 2021 does not have the luxury of sending away and demotivating close to 1,500 medical interns and over 8,000 doctors.

The writer is a health equity advocate